India has become a global COVID-19 hotspot and has recorded the single highest daily spike in new cases in the world. One of the reasons for the surge in cases in the second wave of the pandemic has been the evolution of the B1.617 variant which has been seen to increase transmissibility and possible resistance to treatment or vaccines.
The emergence of the B1.617 variant has led to the UK banning travel from India with the US also updating its travel advisory to warns against travel to the country.
With many questioning the variant's resistance to treatment and vaccines, it has become important to understand how dangerous the mutation is and what countries and the public can do to fight it. We spoke with Dr Jeremy Kamil, Associate Professor of Microbiology and Immunology at the Louisiana State University Health Sciences Center at Shreveport to get a better understanding.
Govindraj Ethiraj: What is your response and understanding of this particular mutation and the manner in which countries like the UK have now banned travel?
Dr Jeremy Kamil: I am shocked by these travel bans. I think they are discriminatory against countries such as India. I cannot imagine any reason why UK, which is where B117 originated, which is a very concerning variant, why weren't they banning travel from England to India to protect India from their scary variant.
It puzzles me that every time we find a new variant, and we are going to find new variants, some of them are going to be of somewhat increased transmissibility, maybe a tiny bit is going to resist vaccines, but all these variants are going to be controlled by the current vaccines. So, it is important to understand that B1617 variant, it does have some mutations on it that have been found in the other variants, so I do not see something spectacularly concerning in itself.
I think that the big wave of infections seen in India is most likely due to human behaviour. This is because people are mixing indoors without masks and India is a very crowded country with a very large population. So, when you have a lot of people in a small space, without wearing masks or following advisories, you are going to see spikes in cases.
I do not believe that the spike in cases is solely driven, exclusively driven by the phenotypic difference with this virus. I really do disagree with those travel bans. I think there are concerning variants all over the world. It is important that people wear masks on airplanes and get tested before travel.
But this is not a new pandemic. It is the same pandemic that we were in since December 2019, when the virus emerged in China. I am very troubled to see the travel bans because I think they are discriminatory.
GE: Are you saying that there is no fundamental distinction in transmissibility except of course what is evident, which is that it is more infectious? Otherwise, it retains all the characteristics of the SARS-CoV2 virus that came upon us last year?
JK: I have to stress that we do not have laboratory data yet on this variant as far as increased transmissibility or resistance to vaccines. So, we have to take data from the other variants that have some of these mutations and infer what we would expect to see. But by the number of mutations in the spike, there is about five mutations, or substitutions on the spike which are different from the parental virus which is basically a G614 spike, which is now the dominant spike. And this a fewer number of mutations relative to B117 when it emerged.
It had eight mutations in the spike. It is not a particularly frightful variant from the spike configuration, I would say. It is concerning, and I would classify it as eligible to be called a variant of concern, but you need to get laboratory data.
As far as some of the mutations we would expect the E484Q mutation to possibly resist neutralising anti-bodies as we know E484K does. And that mutation is found in the P1 and B1.351 variants that are variants of concern. But again, vaccines control the most terrible consequences of any of those variants which are hospitalization and death.
If you get a good vaccine, which most of the vaccines are, you will be protected from the worst consequences. So, it is important that people do not lose sight of the fact that these variants are not super viruses, they do not escape vaccines altogether. They are probably more likely to reinfect someone who has already recovered from a natural case of COVID than someone who has been given a good vaccine.
We know that the vaccines give a more uniform protective response than recovery from natural infection. Recovery from natural infection you get all over the map, some people can be reinfected very easily, the people who get sicker from natural infection, when they recover, they are protected pretty well. You do not want to be on your deathbed from this virus.
GE: With reference to this specific mutation and in general why would say or what gives you the confidence that any of these are a sure shot solution to ensuring that the fatalities are low and people only suffer mildly?
JK: AstraZeneca vaccines are/seem to be very very effective from protecting people from becoming dangerously ill. I have heard that even China has come out and said that their inactivated vaccine, there are a bunch of different vaccine candidates in China...I am sure that some of them are good but their inactivated vaccines, they have been disappointed with their own results and they have come out and said that.
So, I do not want to make claims about inactivated vaccines. But any of the adenovirus vectored vaccines or the mRNA vaccines are going to protect you fantastically well on an individual basis from any risk of becoming seriously ill. I am not going to say that it is absolute. There is always going to be an expectation of the rule. But on an individual basis, if you get the AstraZeneca vaccine for instance, you have excellent protection against the risk of being seriously ill.
GE: In some ways therefore, you are also confident about the evolution of the virus itself, how far it could go and how dangerous it could become?
JK: So, there is a really important paper that came up from Sarah Cobey and some co-authors from the University of Chicago and the title of the paper is along the lines of why virus evolution should not drive vaccine hesitancy. And she and her co-authors showed with very beautiful mathematical models rooted in excellent evolutionary genetics and medicine that these vaccines are very very likely to protect us and so it is important that we do not lose sight, just because these viruses are mutating and evolving a little a bit, which is exactly what we expect them to do that should not make people think that the vaccines are not going to work or they should delay in getting a vaccine.
Exactly the opposite, you should get a vaccine as quickly as possible because that is going to push the virus into a smaller evolutionary space where it does not have room to innovate anything any more. The more the virus can run free, the more it can, it is almost like a little entrepreneur, start new business plans or experiment how to get past neutralising antibodies.
But any of those things the vaccines are fantastically effective and our immune systems are elegant and amazing. They have multiple layers and the vaccines basically give the immune system the key to unlock all these abilities that the immune system has to control a virus.
So, we do not want to lose sight of that just because the virus can infect someone a little a bit and get past the neutralising antibodies does not mean that vaccines are failing. Infection is not the same thing as disease.
GE: On the B1617 variant which we are currently dealing with, would you say that it is the most fearsome or dangerous version of the virus that you have seen or have there been other mutations in the last six months?
JK: What we are seeing most of all is the recurring emergence or independent emergence. When the virus spilled into us from a bat or an animal species, it creates its own family tree and you are seeing the same types of mutations occurring on lots of different branches of that virus family tree. I do not think that B.617 is likely to prove the scariest variant yet. It is probably a mid-way puncher, probably an interesting variant from a scientific perspective.
But as far as the general public, it is COVID-19. Do not freak out, calm down, get the vaccine and yes, realise that this virus can affect you and realise that this virus is always going to be changing little by little. It cannot completely change everything about itself and outsmart all our vaccines and immune systems.
It is basically the same virus from December 2019 from Wuhan China, maybe with a fake moustache on and sunglasses and a wig. But it cannot outsmart your immune system. Your immune system is fantastic. So have faith in your body's ability to fight viruses, especially if you have had training from a vaccine.
GE: This particular mutation has obviously taken hold of India and yet, we are also seeing the number of vaccinations rise. Is there a point where, because we are not vaccinating fast enough or enough people, that the virus mutation may speed up or it may mutate faster and differently?
JK: Well, the virus' mutation rate is fixed. But when you deal with large populations of humans who are people that are spreading the virus, it is the number of infection events that is driving evolution. The virus is constant in its rate of changing its genome and just because it is not perfectly faithful in copying its genome when it replicates and again a lot of those mutations are harmless or even harmful to the virus.
It is just every once in a while, the virus, so to speak, wins the lottery and finds a mutation that makes it a little bit more infectious to the human cell and particularly when it infects an immunocompromised person, when it is in an immunocompromised person it can infect for longer, it starts to come up with variants like B117. And variants like that you see a lot of mutations appearing suddenly at once because it really had time to adapt to the human body.
But it does not get that comfortable space to get acquainted in a normal infection. But in an immunocompromised it is different. So that is more what drives it.
GE: One of the points that you had made in my last interview with you was the GISAID database. Are you happy with the data sharing particularly from countries like India? Are you getting enough for you to make your own analysis?
JK: I would say that India has improved its sharing on GISAID. I think all countries need, all researchers and locations around the world need to realise that when you sequence a virus like a flu virus or SARS CoV2, and you make that data available by participating in the GISAID programme, you are retaining your power as an author.
Because GISAID literally enforces that people must cite you by name and recognize your work, and this is very very important. There is some controversy in the scientific field right now because there are idealistic people who think that data should just magically be on their computer and they can do whatever they want with it, and relegate the authors to a database code in a (supplementary) file.
And that is unacceptable for real-time sharing of data. If you want scientists and public health workers to go and gather these samples, decode and sequence them in real-time, it needs to be incentivised and fair. I would go one layer further--if you look at marginalised communities, the poor, the hungry, they need to know that we are not just coming in and taking something from them and using their bodies as an incubator to study viral evolution and write core/cold scientific papers.
This data is valuable. It can save lives; it can develop new medicines and vaccines and people can profit and make money of it when it is shared in real time. So, the world needs to have a conversation with itself in the open about how do you incentivise data sharing, how do you empower the poor, the marginalised and everyone to know that what they are sharing is valuable. Not just authors, but also people because we all need to be submitting samples regularly so that we can have a live view of all these trends.
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